Ottenhausen Malte, Banu Matei A, Placantonakis Dimitris G, Tsiouris A John, Khan Osaama H, Anand Vijay K, Schwartz Theodore H
Department of Neurological Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
Department of Neurosurgery, New York University, New York, New York, USA.
World Neurosurg. 2014 Sep-Oct;82(3-4):442-9. doi: 10.1016/j.wneu.2014.03.032. Epub 2014 Mar 20.
Suprasellar meningiomas have been resected via various open cranial approaches. During the past 2 decades, the endoscopic endonasal approach has been shown to be an option in selected patients. We wished to examine the learning curve for parameters such as extent of resection, visual outcome, and complications.
We retrospectively reviewed a consecutive series of patients in whom suprasellar meningiomas were resected via an endonasal endoscopic approach between 2005 and 2013 at our institution. After June 2008, our surgical technique matured. Using this time point, we divided our case series into 2 chronological groups, group 1 (n=8) and group 2 (n=12). This cut-off also was used to examine rates of gross total resection (GTR) and visual improvement. Case selection criteria in successful and unsuccessful cases were examined to determine important principals for case selection.
Mean patient age at surgery was 57.05 years (range, 31-81 years). Mean tumor volume was 11.98 cm3 (range, 0.43-28.93 cm3). Overall, GTR was achieved in 80%, and vision improved or normalized in 14 patients (82.4%) with no occurrence of postoperative visual deterioration. Rates of GTR increased from 62.5% (group 1) to 91.7% (group 2). Visual improvement increased from 75% (group 1) to 88.9% (group 2). Rates of cerebrospinal fluid leak were 25% in group 1 and 0% in group 2. Average follow-up was 51.5 month (range, 3-96 months).
Once the learning curve is overcome, surgeons performing endonasal endoscopic resection of suprasellar meningiomas can achieve high rates of GTR with low complication rates in well-selected cases.
鞍上脑膜瘤已通过多种开颅手术入路进行切除。在过去20年中，经鼻内镜入路已被证明是部分患者的一种选择。我们希望研究诸如切除范围、视力结果和并发症等参数的学习曲线。
我们回顾性分析了2005年至2013年在本机构通过鼻内镜入路切除鞍上脑膜瘤的一系列连续患者。2008年6月后，我们的手术技术成熟。利用这个时间点，我们将病例系列分为两个按时间顺序排列的组，第1组（n = 8）和第2组（n = 12）。这个分界点也用于检查全切除率（GTR）和视力改善情况。检查成功和失败病例的病例选择标准，以确定病例选择的重要原则。
手术时患者的平均年龄为57.05岁（范围31 - 81岁）。平均肿瘤体积为11.98 cm³（范围0.43 - 28.93 cm³）。总体而言，80%实现了全切除，14例患者（82.4%）视力改善或恢复正常，且未发生术后视力恶化。全切除率从第1组的62.5%提高到第2组的91.7%。视力改善率从第1组的75%提高到第2组的88.9%。第1组脑脊液漏发生率为25%，第2组为0%。平均随访时间为51.5个月（范围3 - 96个月）。
一旦克服学习曲线，进行鞍上脑膜瘤鼻内镜切除的外科医生在精心选择的病例中可以实现高全切除率和低并发症发生率。
